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AOHP 2013-2015 Public Policy Statement

Executive Summary
The Association of Occupational Health Professionals in Healthcare (AOHP) is a national association whose members represent thousands of healthcare workers (HCWs). AOHP is dedicated to promoting the health, safety and well-being of workers in healthcare and strives to influence legislation, regulations and public policy that positively affect employee/occupational health in healthcare. To that end, AOHP has developed a Public Policy Statement for 2015-2017 that specifically addresses health and safety concerns in healthcare. These key areas of focus for the next two years have, in part, been identified by the 2015 AOHP membership survey and needs assessment, as well as through the partnerships AOHP has developed. 

Public policy areas of focus for AOHP from 2015 - 2017 include:
•  Overall HCW safety and health with a focus on The Joint Commission’s (TJC) 2012 landmark monograph Improving Patient and Worker Safety: Opportunities for Synergy, Collaboration and Innovation.
•  Development of the occupational health professional (OHP) through education, leadership opportunities, professional advancement and mentoring.
•  Promoting initiatives to reduce bloodborne pathogen exposures, including participation in research, such as the EXPO-S.T.O.P. survey, leading to the establishment of a national database of significant exposures.
•  Supporting efforts to increase influenza vaccination rates among HCWs, including research that will lead to evidence-based best practices for immunization.
•  Safe patient handling efforts, including participating on the multidisciplinary team that developed national guidelines for safe patient handling and mobility, and continued support of regulatory efforts to promote safe patient handling programs in healthcare nationally.
•  Collaborating with partners in the dissemination of respiratory protection competencies and implementation strategies for respiratory protection programs, including the development of educational resources for HCWs.
•  A continuing commitment to working with partners to achieve the goal of a safe and healthy work environment.

The remainder of this statement will provide background and details in the formulation of these public policy efforts.

For more information, please call AOHP Headquarters at (800) 362-4347 or e-mail info@aohp.org.

Overall HCW Health, Safety and Well-being
AOHP supports all efforts to reduce and eliminate occupational hazards in the healthcare setting. HCWs experience some of the highest rates of non-fatal occupational injuries and illnesses. In November 2012, TJC published a landmark document, Improving Patient and Worker Safety: Opportunities for Synergy, Collaboration and Innovation. Developed in conjunction with the National Institute for Occupational Safety and Health (NIOSH), National Occupational Research Agenda (NORA), Healthcare and Social Assistance Sector, this document is “intended to stimulate greater awareness of potential synergies between patient and worker health and safety activities.”

AOHP disseminated this document to its membership at the time of publication and recommends its use in the creation of a safe working environment. The document also serves as a platform from which AOHP will continue to address areas of public policy identified as priorities in its 2015 membership survey.

OHP Development
It is important that OHPs be recognized as experts in the field of employee/occupational health. AOHP promotes member advancement and expertise through education, leadership development, professional advancement and support. AOHP cultivates this expertise by offering: a national conference with varied learning levels (beginner, intermediate and advanced); local chapter education programs; mentoring; and leadership development through the Congress of Presidents and initiatives of the national Executive Board members. Professional development is vital to AOHP in demonstrating expertise and promoting recognition of the valuable role occupational health plays in high quality care delivery, in addition to strengthening member value.

Working with Partners
AOHP remains committed to working with partners to achieve the goal of a safe and healthy work environment. Partners include TJC's Nursing Advisory Council, the Centers for Disease Control and Prevention (CDC), NIOSH, NORA's Healthcare and Social Assistance Sector, the American College of Occupational and Environmental Medicine (ACOEM), and other accrediting agencies and nursing associations. AOHP will begin exploring opportunities for collaboration with the Association for Practitioners in Infection Control and Epidemiology (APIC) and the National Tuberculosis Controllers Association.

Bloodborne Pathogen Exposure
AOHP is concerned about the ongoing occurrence of significant blood/body fluid exposures. Underreporting of significant exposures, timely testing of exposed HCWs and source patients, and the establishment of a current national database of significant exposures are areas that must be addressed. AOHP advocates for policy that supports a more secure environment for employees through the use of safer technology, education, training and prevention regarding sharps injuries. AOHP is working on these issues in conjunction with key partners such as NIOSH and the CDC.

The timely testing of the source patient for HIV is critical to the evaluation and management of a HCW who has sustained a blood or body fluid exposure. This shortens the time before necessary HIV anti-viral prophylaxis is delivered, eliminates the need for follow-up testing and reduces the level of worker anxiety regarding the exposure. Currently, Nebraska is the only state that requires special written consent for HIV testing. AOHP supports the 2006 CDC recommendation for HIV testing of adults, adolescents and pregnant women in healthcare settings (Recommendation and Reports, September 22, 2006/55 – RR14); that  HIV screening be incorporated into the general consent for medical care after the patient is notified that testing will be performed unless the patient declines or opts out.

During 1985–2013, 58 confirmed and 150 possible cases of occupationally acquired HIV infection among HCWs were reported to the CDC; since 1999, only one confirmed case (a laboratory technician sustaining a needle puncture while working with a live HIV culture in 2008) has been reported (Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC, unpublished data, 2014). The CDC advises that “Occupational exposure to bloodborne pathogens from needlesticks and other sharps injuries is a serious problem, resulting in approximately 385,000 needlesticks and other sharps-related injuries to hospital-based HCWs each year. Similar injuries occur in other healthcare settings, such as nursing homes, clinics, emergency care services and private homes. Sharps injuries are primarily associated with occupational transmission of Hepatitis B virus (HBV), Hepatitis C virus (HCV) and human immunodeficiency virus (HIV), but they have been implicated in the transmission of more than 20 other pathogens.”

Based on the magnitude of sharps injuries in the healthcare setting, AOHP supports efforts to reduce these types of injuries through a comprehensive approach that includes: the development of sharps engineering controls and safer medical devices; injury prevention teams to evaluate sharps injuries; administrative controls; and HCW education. In addition, AOHP supports strategies and processes that encourage the prompt reporting and follow-up of significant exposures. AOHP will explore opportunities to collaborate with organizations such as the Association of periOperative Registered Nurses (AORN) to reduce sharps injuries and bloodborne exposures.

To address the lack of a current national database of sharps injuries, in 2012, AOHP developed a sharps injury survey for its membership. The survey, EXPO-S.T.O.P., was first distributed to the AOHP membership in early 2013 and then annually since that time, with ongoing analysis of the annual survey data. The survey will continue to be distributed annually to the AOHP membership to gather sharps injury data from the workplaces of AOHP members across the nation and beyond. In addition, AOHP will continue its collaboration with NIOSH in the development of the Occupational Health and Safety Network (OHSN) module related to bloodborne exposures.

Influenza
In 2011, AOHP published a position statement on influenza vaccination for HCWs. AOHP will continue to support efforts to provide influenza vaccine, free of charge, to HCWs on an annual basis. AOHP supports continuing research to develop evidenced-based practice related to influenza transmission in the healthcare environment and vaccination of HCWs. Prompt communication of current study findings to AOHP and partnering organizations is critical in improving influenza prevention programs. In addition, AOHP will seek opportunities to evaluate the tracking of HCW influenza vaccination rates as they become available through the National Healthcare Safety Network.

Safe Patient Handling
AOHP supports efforts to ensure a safer healthcare environment for both the patient and the employee, including utilizing lift/assist devices as the primary method for the prevention of musculoskeletal injuries. More than 40 years of instructing HCWs on proper body mechanics has done little to impact injury statistics. Back injuries and other musculoskeletal disorders related to patient handling are the leading cause of workplace disability for nurses and other direct patient care providers. Injury and illness data from 2011 reveal that nursing aides, orderlies and attendants had a rate of injuries and illnesses of 444 per 10,000 full-time workers. Registered nurses (RNs) had an injury rate of 136 per 10,000 full-time workers. This represents 39,980 and 21,570 days away from work, respectively. Home health aides had 7,490 days away from work.

In 2013, musculoskeletal disorder cases accounted for 53 percent of total cases that occurred to nursing assistants. With the average cost of a back injury at $10,689 per case, these injuries represent a significant impact on both the injured worker and the healthcare employer.

For patient transfers, lifts and repositioning, mechanical equipment must be provided by the facility and used by the caregivers. AOHP advocates for regulations, legislation, education, training, research and prevention activities as related to safer patient handling activities and methodologies. AOHP will work to influence both state and national legislation as it relates to safe patient handling. AOHP was privileged to participate in the national task force that published the Safe Patient Handling and Mobility Interprofessional Standards and Implementation Guide and Implementation Guidelines to Safe Patient Handling and Mobility Interprofessional National Standards.

Respiratory Protection
AOHP supports efforts to ensure a safer workplace for employees by utilizing systems and processes that are evidence-based and supported through research. AOHP advocates for increased research, training and education related to respiratory protection for tuberculosis (TB), other airborne respiratory transmissible diseases and emerging infectious diseases such as Ebola. AOHP developed its position statement titled Respiratory Protection for HCWs in 2015.

With the AOHP/NIOSH Memorandum of Understanding, a collaborative relationship has continued with the National Personal Protective Technology Lab (NPPTL) in Pittsburgh, PA, where groundbreaking healthcare-related research is being conducted on the need for annual fit testing, general respirator use, and respirator use in pandemics and other related areas in healthcare. AOHP strongly supports NIOSH’s efforts to scientifically determine the need for annual fit testing, as well as the need for training and education regarding respiratory protection according to OSHA’s Respiratory Protection Standard and the CDC’s Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005.

The respiratory transmissible disease TB continues to be an ongoing infectious disease issue in the healthcare setting. Diagnosis of the disease is most important in preventing its spread, along with regular screening of HCWs. The current ruling from OSHA is that the particulate respirator recommended for personal protection against TB is included with the Federal Register for General Industry Respiratory Protection standard. This regulation requires annual fit testing and education for all respirator wearers.

AOHP will continue to be actively involved with the issue of respiratory protection by participating on two national multidisciplinary teams:

  • The Institute of Medicine’s (IOM) Respiratory Advisory Group was formed in 2011 after the release of the IOM Letter Report Occupational Health Nurses (OHNs) and Respiratory Protection: Improving Education and Training. The work of the group has led to the development of OHN competencies for respiratory protection and to the creation of the online Respiratory Protection Education and Resource Webkit. Efforts continue on the development of respiratory protection educational products for a variety of HCWs. AOHP will continue to collaborate in the development of these resources.
  • Through TJC's Technical Expert Panel, which conducted a survey on exemplary respiratory protection practices, the monograph Implementing Hospital Respiratory Protection Programs: Strategies from the Field was published in May 2015.

In addition, the NIOSH Hospital Respiratory Protection Program Toolkit, published in May 2015, will be disseminated to AOHP members as a valuable resource in establishing respiratory protection programs.

Workplace Violence
Workplace violence can range from offensive or threatening language to homicide. NIOSH defines workplace violence as violent acts (including physical assaults and threats of assaults) directed toward persons at work or on duty. The Healthcare and Social Assistance Sector documented 113 fatal injuries for 2011. This includes physician and dentist offices, laboratories, home care and ambulance services. In 2012, the Sector reported 13 percent of the injuries and illnesses were the result of violence, and that the rate increased for the second year in a row, from 15 to 16.2 cases per 10,000 full-time workers. Fifteen percent of the days-away-from-work cases for nursing assistants were the result of violence and other injuries by persons or animals. Hospitals documented 33 fatal injuries in 2013, an increase from 20 in 2012. Data from 2013 also reveal that the most frequent type of assailant in workplace homicide involving a woman was a relative or domestic partner. HCWs who provide direct care have a high risk for workplace violence due to the populations they serve, including those who may have altered mental status related to the influence of drugs and alcohol, psychiatric disorders, pain, multiple psychosocial stressors or grief.

AOHP supports implementing comprehensive violence prevention programs that are risk specific to the healthcare organization or facility. A comprehensive violence prevention program must include: a written program; management commitment; employee participation; hazard identification; safety and health training; and hazard prevention, control and reporting. Periodically, it is critical that the healthcare organization’s violence prevention program be evaluated and updated. These violence prevention programs need to address co-worker or lateral violence, as well. Case reports of prevention strategies that have reduced workplace violence in the healthcare setting include installing metal detectors at Emergency Department entrances, establishing a violent patient database, and limiting visitor access to specific floors or areas via a GPS tracking badge. AOHP supports and encourages healthcare organizations to endeavor to protect their patients, employees and visitors from acts of violence, as well as to advocate for further research on prevention strategies for workplace violence.

Through AOHP’s Memorandum of Understanding with NIOSH, AOHP participated in the development of an online education program for OHPs to share best practices to reduce workplace violence. This online educational product was released in 2013.

Conclusion
AOHP is recognized as the definitive resource for issues related to workers in the healthcare setting and holds the exclusive mission of addressing the needs and concerns of OHPs in healthcare. As the leading authority for occupational health in healthcare, AOHP is dedicated to promoting the health, safety and well-being of workers by:

        •  Advocating for employee health and safety.
•  Occupational health education and networking opportunities.
•  Health and safety advancement through best practice and research.
•  Partnering with employers, regulatory agencies and related associations.

For more information, please call AOHP Headquarters at (800) 362-4347 or e-mail info@aohp.org.

References
Bureau of Labor Statistics. 2011. Non-Fatal Occupational Injuries and Illnesses Requiring Days Away From Work. Retrieved 1/13/13 at http://www.bls.gov/news.release/archives/osh2_11082012.pdf.

Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report. Notes from the Field: Occupationally Acquired HIV Infection Among Health Care Workers — United States, 1985–2013. January 9, 2015 / 63(53), 1245-1246. Retrieved 6/27/15 at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6353a4.htm.

Centers for Disease Control and Prevention. National Institute for Occupational Safety and Health. Hospital Respiratory Protection Program Toolkit. Retrieved 7/8/15 at http://www.cdc.gov/niosh/docs/2015-117/?s_cid=3ni7d2hospitalresp06012015.

Centers for Disease Control and Prevention. National Institute for Occupational Safety and Health. Occupational Violence Training and Education - Workplace Violence Prevention for Nurses. CDC Course No. WB1865 - NIOSH Pub. No. 2013-1. Retrieved 7/8/15 at http://www.cdc.gov/niosh/topics/violence/training_nurses.html.

Centers for Disease Control and Prevention. National Institute for Occupational Safety and Health. Stop Sticks Campaign. Retrieved 7/8/15 at http://www.cdc.gov/niosh/stopsticks/.

Centers for Disease Control and Prevention. National Institute for Occupational Safety and Health. Workplace Safety & Health Topics. Occupational Violence. Retrieved 7/8/15 at http://www.cdc.gov/niosh/topics/violence/.

Centers for Disease Control and Prevention. State HIV Testing Laws: Consent and Counseling Requirements. Retrieved 7/8/15 at http://www.cdc.gov/hiv/policies/law/states/testing.html.

Department of Health and Human Services. Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report. December 30, 2005. Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings. Vol. 54 / No. RR-17. Retrieved 1/13/13 at http://www.cdc.gov/mmwr/pdf/rr/rr5417.pdf.

Department of Health and Human Services. Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health. 2009. State of the Sector, Healthcare and Social Assistance. Identification of Research Opportunities of the Next Decade of the National Occupational Research Agenda. DHHS (NIOSH) Publication No. 2009-139, August 2009.

Institute of Medicine. Occupational Health Nurses and Respiratory Protection: Improving Education and Training – Letter Report. August 11, 2011. Retrieved 1/13/13 at http://www.iom.edu/Reports/2011/RespiratoryProtectionNurses.aspx.

The Joint Commission. 2012. Improving Patient and Worker Safety: Opportunities for Synergy, Collaboration and Innovation. The Joint Commission, Oakbrook Terrace, IL. Retrieved 1/13/13 at http://www.jointcommission.org.

US Department of Labor. Bureau of Labor Statistics - Industries at a Glance - Hospitals. Retrieved 7/8/15 at http://www.bls.gov/iag/tgs/iag622.htm.

US Department of Labor. Occupational Safety and Health Administration. 1998. Respiratory Protection. – 29 CFR 1910.134. Retrieved 7/8/15 at https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_id=12716&p_table=standards.

Approved: August 2015

 

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